Dehradun, India Fall 2009

Burn Patients

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

Burn patients are the most dramatic in appearance.  How a person got burned varies from case to case, but in general, they are all related to some form of cooking accident.  Cooking on open fires or using fuel-based fires leads to many devastating accidents.  The result is facial, neck, trunk, and hand injuries on the front of the body. Poor families do not have access to electricity and live far away from hospitals or ambulances. Burn victims’ skin appears as if it were melted; the joints beneath these contractures can no longer find a way to function under that tight skin, making reconstructive surgery vital in order to salvage their functionality and movement.

Thoughtful Inquiries

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

Two brothers came in together for the younger to be seen.  The older brother sat beside his brother while the younger was interviewed.  On a couple of occasions, the pediatrician would ask the patient a question, and at the same time the older brother nodded affirmation while the younger brother denied the issue at hand.  Then little brother was asked if he had any questions for us.  For the next 20 minutes, out came the most astute and careful questions I have ever heard from a child!  How long would he be asleep?  How long would they operate?  What were they going to do to him?  Would it hurt when he woke up?  And so on.  It was delightful and entertaining at the same time.

Capturing Bliss

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

There are always patients whom everyone remembers.  This picture captures Dr. Yogi playing with this tiny patient, bumping heads.  They were both laughing, and she was delighted by his attention. Whenever he would touch foreheads with her she would close her eyes and you could see the bliss in her face.  We all have differences around the world, but moments like these we can all savor the similarities. Witnessing Dr. Yogi's commitment to his patients and the love he treats them with was inspirational.

Immortalized Repairs

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

Once I arrived at the hospital, Madhu, one of our coordinator/ translators, gave me a quick tour of the building.  I could hear the distant buzz of waiting families and volunteers organizing potential patients for their evaluations. 

As we walked, a pile near the building caught my attention. For the treatment of certain cases Dr. Yogi is required to make plaster casts of his patients’ faces. The pile was a collection of those plasters. Still expressions gazed out from the pile. It was haunting and beautiful at the same time, to see some of the facial deformities immortalized from before the repairs that transformed their owners.

The Hospital

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

The hospital is actually a converted two-story house.  The area for the physical and occupational therapy is upstairs.  Since this trip will consist mostly of burn patients, there will be much work to do post-operatively in the way of splints, range-of-motion, exercise, dressing changes, and education.

Our hosts are Interplast’s surgical outreach director, Dr. Yogi and his son Dr. Kush. Together they do much work for the people of this area year round. They are wonderful facilitators for our team, and assist and do cases too.  They are Interplast’s outreach partners and continue this invaluable work well after the team leaves.  It is the mission of Interplast not to come into an area and simply perform procedures, leaving a void behind, but to integrate, teach and eventually turn over the reconstructive surgical work to the local people. The old “teach a man to fish” approach. And that’s what Interplast has done here, but there is such a great need that teams are needed to help with the backlog of cases.

There are more than 10,000 burn victims (most of them children) in this area alone.  Most of them are extremely poor and would otherwise never have access to these procedures.  When they receive surgery, whether from Dr. Yogi and Dr. Kush or from the Interplast surgical team, they are forever grateful and many remain to help Dr. Yogi with his work.

An Eventful Walk to Clinic

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

Clinic days are always fun on Interplast trips.  We get to meet so many families and children, and see how the local people dress and interact.

The team made its way to the clinic, which was a few miles beyond the hospital.  I was designated to finish set-up at the hospital on my way to the clinic.  I realized after everyone had left that I had no contact information for the transporter vans. So, with little encouragement and much delight, I walked to the hospital, which is not far from and on the same street as the hotel.

It was here that I remembered New Delhi from my many visits almost 35 years ago. Overloaded motorbikes, three-wheeled taxis, speeding cars, and lorries of all sizes.  The idea is to drive on the left, as in Britain, but this only happens when the road has a center divider that is several inches high.  Without the divider, all bets are off and the dance/slalom that results is amazing to see.  Add to this many pedestrians, bikes and random cows, and it is nothing short of chaos.  Into this I ventured to make my way to our little hospital.

At one point, I found myself walking behind a large white bull.  He had the shape of a Brahma bull and was every bit as large, with a large protrusion over his withers and long corkscrew horns with pointy ends.  The whole package was very threatening.  I think he might have been as tall as my shoulders, but each time I look back on this event, he seems to become taller and his horns longer and pointier.  I think now I can even see steam coming out his nostrils.

Finally the driveway of the hospital appeared.  It was obvious, because there is a large sign on the road that says, “Free Plastic Surgery Camp – Super Specialist Visiting From USA”, followed by all our names. One third of our team is from other countries (Nepal, India, Pakistan, and New Zealand), but that would be too long to list, I guess.  Behind the sign is a man sitting on the sidewalk under a canopy, selling bananas.  The whole experience feels surreal.

Setting Up the Operating Rooms

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

This evening, we quickly moved all boxes and bodies into various vans and vehicles and made our way to the hospital we will be using.  In no time, our colony of ants went to work loading, unloading, opening boxes, distributing goods, setting up two operating rooms, a central supply area, lounge and storage room, recovery room, occupational therapy consultation space, and an autoclave and equipment cleaning space.  Before our eyes, we created an operating room from top to bottom. Luckily, we already had walls, surgical beds, stands and storage shelves with which to work.  Everyone pitched in: the two surgeons, the two occupational therapists, the four nurses, the three anesthesiologists, the pediatrician and the two coordinator/translators.  We all start out very familiar with all aspects of the environment, which enables us to better work together to get things done.

Finally in Dehradun

Dehradun, India-Bonnie MacEvoy, Interplast volunteer anesthesiologist.

Finally, it was time for the last leg of our trip, more than 48 hours for me after my original departure.  We all met in the lobby and loaded into the bus again by 9 a.m.  At this point, we met up with the remaining two of our team, Dr. Kiran Nakarmi, Interplast’s surgical outreach director in Nepal, and Mohan Dangol, an occupational therapist, also from Nepal.  The 14 of us arrived at the New Delhi Airport, went through very strict security, and on to our local flight to our final destination.  At least this time we did not have the large and heavy cases and boxes to deal with; they had gone on ahead in a truck to travel overland and meet us in Dehradun.

About an hour later, we made our approach into Dehradun.  Most of the flight was clouded below us, but as we descended, the air cleared.  We made our approach into the foothills of the Himalayas, which were covered with thick, lush greenery.  The mountains here are below the snow line, and covered with trees and large, bushy plants.  It is a large city, but then this is a very populated nation.

Everyone piled into the buses for the last time, all boxes and bags in tow.  The ride was our first introduction to this area, and it is beautiful.  Most notable to me was the large population of orange-ish Rhesus Monkeys, all parading and strolling along the road side.  They seem to make themselves at home in the road of speeding vehicles, and yet – while no one seems to avoid them or brake – there is no monkey road kill that I can see.

We arrived at our hotel in early afternoon, and our host’s son Dr. Kush, who is also a physician, his wife and children, and waiters with lemonade, greeted us. Dr. Kush’s wife and children ceremoniously decorated each of us with a garland of marigold and a Hindi mark of paint and rice grains on our foreheads.  We have officially arrived!

Arriving in a Different Time Zone

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

It’s amazing how much baggage everyone is carrying these days.  Either consumption or hoarding is way up; the new charges for checked bags are leading to bloated carry-ons, or a bit of both.  Hats, duty-free, roller suitcases that ought to be checked, baby diapers, souvenirs, books and cosmetics—the overhead bins are brimming to the point that openers take the risk of being showered with chunks and parts that have shifted during take-off.

We finally landed in New Delhi, in a time zone that is 12.5 hours later than San Francisco, which meant we arrived the evening of Saturday, September 12.  We were all hot, sweaty, disoriented and ready to bolt off the plane.  A bus met us, but it took some time to get our personal baggage, pick up the boxes, and get through customs. Luckily with us were coordinator/translators Jogi and Madhu, who both speak Hindi and could get us through the bureaucracy and protocol.

By the time we hooked up with our 13th team member from New Zealand, loaded 45 boxes and bags, got 12 people and their carry-ons inside the bus and headed for the hotel, it was almost midnight. For most of us, this is a large time change, and it was difficult to remember which end was up.  We limped into our rooms and fell into bed.

San Francisco to Chicago

Dehradun, India--Bonnie MacEvoy, Interplast volunteer anesthesiologist.

Up early, to the shuttle, and into the airport, again.  This is starting to feel like a recurring theme.  Today marks the anniversary of September 11, so it is a stressful date to travel by air, but I can’t focus on that. Slowly some of the team members arrive, a total of five of us who are traveling from California. We were all assembled when the boxes arrived from Interplast.  Sixteen cartons and 17 hearty black boxes, all packed to the gills.  The supplies in the cartons are used during the trip, so we only return with the 17 plastic boxes. 

Our 9:45 am plane was delayed, and we finally boarded at 10:30.  We sat on the runway for a while, and then we were off.  Luckily we had a long layover in Chicago, so we were not late. In Chicago we caught up with the additional six team members. Then we were 11, and it was time to board.  Not surprisingly, we spent a lot of time on the tarmac in Chicago, leaving about an hour late.  It has not been a good day for “on-time arrivals.”

These are times of another swine flu scare, and we had a bag of masks for the team to wear if anyone wanted.  I had my mask out, but was delighted to find that rare empty seats surrounded me.

The germ zone was not wrapped so tightly around me, and I also had room to stretch out, which made for a much nicer 14-hour flight.